Medical conference in Augusta focuses on alternatives to prescribing opioids

AUGUSTA — More than 500 medical professionals showed up at a state-sponsored conference at the Augusta Civic Center on Monday that touted solutions to the deepening opioid crisis.

One of the major goals of the wide-ranging conference, hosted by the Maine Department of Health and Human Services, was to show physicians that there are many alternatives to chronic pain management aside from opioids, state officials said.

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Maine had the highest rate in the nation of prescriptions for long-term, extended-release opioids in 2012, according to a report published two years later by the U.S. Centers for Disease Control and Prevention. Helping patients control pain without opioids or with a limited dose is going to increasingly be a topic in 2017 as more requirements from a strict new prescribing law are implemented. The law was approved last year, but due to its complexity and a desire to give doctors and patients time to adjust and comply with the new standards, the implementation has been rolled out over the past several months.

The law caps dosages for opioids at 100 morphine milligram equivalents or less for most patients, limits prescriptions to 30 days and mandates use of the prescription monitoring program to reduce “doctor shopping” for opioids. Opioids have become an ever-increasing health crisis in Maine, and deaths from drug overdoses are now more than twice as common as motor vehicle fatalities, according to the Maine Center for Disease Control and Prevention. In 2016, there were 378 drug overdose deaths compared to 160 motor vehicle deaths.

The prescribing law is one of the strictest in the nation, according to health experts.

One of the reasons for the strong turnout Monday is that the new law requires doctors to take three hours of continuing education every two years, and attending the conference fulfilled that requirement, said Gordon Smith, executive vice president of the Maine Medical Association, a group that represents doctors before the Legislature.

Dr. Christopher Pezzullo, the state health officer, said there’s scant evidence that opioids work for chronic pain, and a lot of research showing opioids are harmful to take long-term.

“We are presenting health professionals with alternatives to opioids,” Pezzullo said, adding that there are dozens of them, such as physical therapy, meditation and exercise. “These are very low-risk treatments to try, as compared to the high risk of opioids.”

Pezzullo said as deaths have spiked and heroin and misuse of prescription opioids has been dominating the news, he’s noticed a shift in thinking among medical professionals. He noted how dangerous the medications can be as a gateway to addiction.

“It’s amazing how much the conversation has changed, and the culture has changed in the last year,” Pezzullo said.

The U.S. CDC says there’s not enough evidence to conclude that opioids are effective in treating chronic pain, and much more research needs to be done.

Dr. Stephen Hull, director of medical pain management at Mercy Hospital in Portland, gave a presentation on the program he runs there in which the goal is to taper patients off opioids completely or greatly reduce their dose.

Hull said he used to be a “high prescriber” of opioids but several years ago became disillusioned with their lack of effectiveness.

“But I couldn’t simply take folks off of opioids without giving them some alternative,” Hull said.

So after studying programs in England, Ohio, Minnesota and New Hampshire, Hull created the “Living Life Well” program at Mercy, which has treated hundreds of patients with a combination of group therapy, exercise, meditation and education on how pain works. Hull said understanding how pain works and why the brain is receiving pain signals is helpful to patients learning to cope with pain.

Hull said the program does not promise patients that their pain will go away, but strives to improve functioning, which helps them live more active lives and usually results in less pain as well.

Smith said the law will help reduce the “gateway” from prescription opioids to heroin or other opiates.

About 75 percent of new heroin users first misused prescription opioids, according to the American Society of Addiction Medicine. Smith said unfortunately many health professionals were not paying enough attention to the crisis before the law went into effect. He said the response for the most part has been positive.

“When you require people to do something, people start paying more attention,” Smith said.

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